Steroid injections: the myth and reality
Dr Ravinder Chadha

A doctor has to counter a lot of queries from patients when they are advised to go in for steroid injections. Patients are apprehensive, as they tend to think that these injections are similar to oral corticosteroids. A layman generally relates oral corticosteroids to a number of side-effects. The necessity is to make people aware that oral corticosteroids have drastic side-effects only when taken in high doses over a prolonged period. These are also confused with anabolic steroids, which are taken by sports persons to enhance performance.

Steroid injections are used in sports injuries, orthopaedic problems like arthritis, tendinitis, frozen shoulder, etc. They are primarily used for their anti-inflammatory properties.

Injection steroids are given into joints for sports injuries, advanced osteoarthritis, rheumatoid arthritis, gout, etc. The ligaments of the knee, ankle and elbow respond immediately to the steroid injection due to their anti-inflammatory effect to reduce pain. Steroids are not directly injected into the ligament but into the tissues around the ligament. Similarly, steroid injections are very useful in the case of tendon injuries, bursitis, etc. A bursa is a space between two structures that move against each other. It can be inflamed in the case of repetitive stress or injury. The most commonly affected bursa is in shoulders, hip, knee, etc.

Joints and soft tissue injuries respond slowly to oral anti-inflammatory drugs in contrast to a small dose of steroid injection, which gives instant relief. These injections are sometimes mixed with local anaesthetic into the area of pain. Usually, these injections are safe, giving discomfort occasionally which subsides within a day. Rarely there may be facial flushing, skin irritation, local numbness, and weakness that also disappears within a short time.

After the injection strenuous activities should be avoided for four-six days. Apply ice to the injected area in the case of pain.

Anabolic steroids used by sports persons to improve performance are different from those used in treating joint and soft tissue injuries. Anabolic steroids have been used to have muscle building effect since World War II. Most of the times sport persons and enthusiastic young men, trying to have immediate results, consume a high quantity of anabolic steroid for an extended period of time leading to its side-effects. They believe that it will also increase strength and endurance. Anabolic steroids increase muscle mass but muscle becomes weak due to the retention of salt and water. The Olympic Association has barred most of these anabolic steroids.

The prevailing myths are as follows:

All steroids are harmful

Oral steroids and anabolic steroids, used over prolonged periods for chronic diseases and enhancing performance, do carry the risk of long-lasting side-effects. Steroid injections when used along with local anaesthetic in small dose relieve pain, swelling and inflammation.

All steroid injections are not painful. This depends on the technique used, degree of inflammation, size of the needle, etc. Steroids are not painful but it is the local anaesthetic that produces temporary tenderness after the injection.

Using high doses over a short period can cause weakness of bones, tendons and ligaments. Therefore, low doses are given over a suitable period of time

The prime aim of an steroid injection is to reduce pain and swelling permanently. If not injected into the inflamed area it may provide only temporary relief. These injections give optimum benefit if given correctly, in proper doses and number along with rest for a few days and with anti-inflammatory drugs.

There is not an iota of truth in this as these injections have no role whatsoever in the development of muscles. They are only used to reduce pain and inflammation of joints and soft tissues.

Due to drastic changes taking place in the field of sports medicine and the importance of steroid injections in injury management, it is the need of the hour to make the people aware of the facts. They should do away with the prevailing myths.

Drugs that increase heart attack risk

LONDON: Risk of heart attack may increase with certain anti-inflammatory drugs. Ibuprofen and other commonly used painkillers for treating inflammation may increase the risk of heart attack, says a study in this week’s BMJ.

Patients should not stop taking the drugs involved — non-steroidal anti-inflammatory drugs (NSAIDS) — but further investigation into these treatments is needed, say the authors.

Researchers looked at the prescribing patterns for these patients, tracking whether and when they had been prescribed NSAIDS. NSAIDS are commonly prescribed to relieve inflammation and pain, and include ibuprofen, diclofenac, naproxen, celecoxib and rofecoxib, plus a host of other less commonly prescribed anti-inflammatories.

The findings were adjusted to allow for several other heart attack risk factors — including age, obesity, and smoking habits.

Importantly, they also adjusted for whether the patient already suffered from heart disease, or whether they were being prescribed aspirin.

Researchers found that for those prescribed NSAIDS in the three months just before the heart attack, the risk increased compared with those who had not taken these drugs in the previous three years.

The newer generation of anti-inflammatories COX-2 inhibitors were also associated with increased rates of first-time heart attack.

Those prescribed the drugs in the preceeding three months were at 21 per cent higher risk of heart attack if taking celecoxib, and 32 per cent increased risk if taking rofecoxib. — ANI

What complicates hernia
Dr Jaswant Singh

Hernia is a common surgical condition affecting all age groups of both sexes.

Q. What is a hernia?

A. It is a protrusion of a viscus — soft tissue — through an abnormal opening. It can occur in any part of the body, but I will confine myself to external abdominal hernia. Peritoneum is innermost thin lining of the abdominal wall. External abdominal hernia is the protrusion of a viscus through a weak abdominal wall area.

Q. What are the types of hernia?

A. There are three types — inguinal (groin) 73 per cent, femoral (just below groin) 17 per cent and umbilical 8.5 per cent, remaining 1.5 per cent are rare.

Q. What are the causes of hernia?

A. In most cases, no cause can be found out.

Q. What are the precipitating causes?

A. Indirect inguinal hernia usually occurs in a congenital preformed sac but precipitating and aggravating causes can be powerful muscular action like lifting heavy weights, whooping cough (children), chronic cough, straining during urination and while passing stools — in adults.

Q. What are the patient’s complaints?

A. In an uncomplicated hernia, a patient has no complaints except a dragging sensation locally and local bulge. However, complaints start with complications.

Q. What are the possible complications?

A. Contents of the hernia ordinarily go back to the abdomen either on lying down, or can be returned manually; this is reducible. When contents cannot be reduced, it is called irreducible. However, there is no obstruction to the flow of intestinal contents. When the flow of these contents gets stopped, we call it obstructed. Here still the blood supply of the wall of intestine is maintained, i.e. the intestine is viable. If still not treated due to the stoppage of blood supply to the gut wall, it becomes unviable. Gangrene of the gut takes place, endangering the life of the patient — a stage which should never be allowed to reach.

Q. What are the complaints in a complicated case of hernia?

A. In an obstructed hernia case, there is pain, vomiting and constipation. There is also generalised abdominal pain.

Q. What is the operative treatment do you advise?

A. Principles of operations are

(a) Exposure of hernial sac

(b) Reduction of its contents — putting the intestine, urinary bladder, etc, back to the abdomen

(c) Ligating or tying the neck of the sac and cutting off the peritoneal pouch emptied of its contents.

(d) Repairing the weak, bulging rear wall of the inguinal canal by various methods.

I am deliberately avoiding the steps of surgery as something should be left for the operating surgeon also.

Early treatment does not reduce epilepsy risk

LONDON: A new study conducted by researchers at the University of Liverpool and published in the latest issue of the Lancet suggests that there is no significant long-term benefit in administering immediate treatment to those with early epilepsy and infrequent seizures.

The team led by Prof David Chadwick found that early treatment does not reduce the patients’ risk of seizure recurrence in the long-term and delaying medication does not increase their risk of chronic epilepsy.

They conducted a randomised trial of 1,400 patients with single or infrequent seizures. Half were assigned to immediate treatment with antiepileptic drugs and half were assigned to deferred treatment, where they received no drug until they and their clinician agreed that treatment was necessary.

The trial found that immediate treatment reduced short-term seizure recurrence but had no effect on long-term outcomes. This was further validated by the fact that more patients in the immediate treatment group than in the deferred group experienced adverse effects that were probably treatment related. There was no difference in the quality of life between the two groups.

"We have shown that a policy of immediate treatment with antiepileptic drugs, mainly with carbamazepine or valproate, reduces the occurrence of seizures in the next one to two years, but does not modify rates of long-term remission after a first or after several seizures. After two years, the benefits of improved seizure control with immediate treatment seem to be balanced by the unwanted effects of drug treatment and there is no improvement in measures of quality of life," Chadwick added. — ANI

WASHINGTON: Mothers who suffer from major depression or anxiety disorders are more likely to give birth to children with asthma and other allergy-based conditions, according to a US study published in Psychosomatic Medicine. There is growing evidence that many weakening and chronic symptoms of ill-health are caused by showing intolerance to certain foods, according to a report in the New Scientist. Ramin Mojtabai, a psychiatrist from Columbia University in New York, assessed the relationship between parental psychopathology and childhood allergy.

The study revealed that 6 per cent of the parents had major depression, 3 per cent had panic attacks and 3 per cent had generalised anxiety disorder. In total, 31 per cent of the children had allergic disorders, including hay fever, eczema, wheezing, asthma and food allergies. "The fact that adoptive parents with depression didn’t show a higher level of asthma in their children provides good evidence for the possibility of common genes for depression and panic disorder on the one hand, and allergic disorders on the other hand," Mojtabai said.

Previous studies had shown an increased risk of depression in the children of parents with allergic disorders.It is unclear why the children of mothers with depression had a higher risk of allergic disorders, but it looks that it might be related to mitochondria —which are inherited through the maternal line — as mutations in mitochondrial DNA have been reported in both atopic and other skin disorders and in bipolar mood disorder, he informed.

"Or it could be to do with genetic imprinting — how some genes are expressed when received from one gender, but not the other," he said.

"Other studies have shown a shared genetic risk for allergy and mood disorders in twins, and that people with depression are themselves more likely to suffer from asthma, although we didn’t find any strong evidence for that," Mojtabai added. — ANI

Bigger brains are not really brainier!

WASHINGTON: A new study conducted by the ANU Centre for Mental Health Research suggests that brain shrinkage, a common symptom of ageing when people hit their 60’s, appears to have no impact on an individual’s capacity to think or learn.

The ANU researchers conducted a combination of MRI scans and surveys of 446 people in their 60’s in Canberra and Queanbeyan.

The research is part of a 20-year study called PATH Through Life and is led by Professor Helen Christensen, the Director of the Centre for Mental Health Research (CMHR).

"The common belief is that the brain shrinks with age and that this shrinkage is linked to poorer memory and thinking. There is also a belief that greater education, or continued, sustained intellectual activity might allow people to better accommodate the effects of brain ageing," Christensen said.

"In this study, we found that, on average, men aged 64 years have smaller brains than men aged 60. However, despite this shrinkage, cognitive functions — like memory, attention and speed of processing — are unaffected. In the present study, we found no relationship between brain shrinkage and education level," he added.

The study found strong associations between childhood adversity and adult depression. Factors most strongly related to depression include mother’s depression, reports of neglectful upbringing, too much physical punishment, having an unaffectionate father, and experiencing a lot of family conflict. Bisexual people tended to suffer more from anxiety, depression and suicidal tendency than homosexual or heterosexual study participants. — ANI